It's not really working, but what would work? I see Trump talking up Health Savings Accounts, but if you don't have money to put in one, what good are they? Tax incentives? Again, if you're poor and paying little in the way of taxes, what would that accomplish?
A Republican friend of mine and I were talking and he suggested that the feds/state come up with a plan to pay for 100% of catastrophic costs over a certain threshold, but one would still have to pay for the cost under the threshold. I suppose if the government were picking up catastrophic costs, the cost of premiums would go down because less would need to be covered.
I can only say as someone who views the whole health care system as a mess (and a costly mess at that), I was hoping for the ACA to do more positive besides lowering the number of uninsured. Granted, if insurers can't make money, they won't participate and the less competition, they higher the costs.